How do you respond to a resident who gets attention by pretending to be in pain?

Nurses General Nursing

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:confused:

I am trying to prepare myself for a CNA interview tomorrow and found this question while searching for CNA interview questions. I'm a brand new CNA so I'm honestly not sure how I would handle this situation:

Mrs. Jones is in the facility for a fractured hip. She constantly likes attn. by putting on the call light pretending to be in pain. Everyone on the hall is ignoring her. You pass by the room and hear her crying what is your response?

Specializes in OB/GYN, Peds, School Nurse, DD.
This was NOT the OP's attitude. She was quoting a site with possible questions for CNAs job interviews.

:clown: We must have posted at the same time. Great minds think alike.

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SWS if you fully read my question you would know I found it while searching for interview questions.

....she's crying and moaning....what makes you think she is trying to get attention? Especially as you have no experience.

I hope you develop a little more compassion as you work...I sure would not want to have anyone taking care of my 86year old mother with an attitude like this.

s

I sure would not want a nurse taking care of me or anyone in my family who didn't know how to read a complete question or directions.

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You need to check on the patient. Pain is what the patient says it is. You would then advise the nurse of the patient's complaint. You never assume anything i.e. patient is pretending to be in pain. Broken hips are painful. Your goal is to make sure they know you understand to check on crying patients and not to go outside of your scope. You want them to see you are compassionate and qualified.

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Specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.
I absolutley agree with the other posters....the pain is what the patient says it is! This poor lady is doing more than saying....she's crying and moaning....what makes you think she is trying to get attention? Especially as you have no experience.

We are taught in nursing school and we observe in clinicals and of course on the floor working that pain is manifested in many ways. Not all of them are verbal. In fact, most are not. I worked in PICU for many, many years. Other than crying, signs of pain are grimacing, guarding, tachycardia, tachypnea, rocking, moaning, and also acting out. This list is not all inclusive. I am sure there are more I am forgetting right now.

THis lady needs an advocate...someone to find out why she is in pain and then FIX it.

I hope you develop a little more compassion as you work...I sure would not want to have anyone taking care of my 86year old mother with an attitude like this.

Unresolved pain is an issue that is near and dear to my heart....I have had 4 major surgeries and know first hand what it is like to lay in a hospital bed in extreme pain and see and hear the staff go on about their business.

Until I called for an anesthesia consult...but that's another story.

s

The CNA is posting this question as a theoretical situation; please re-read her post.

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Just for arguments sake, we will assume the magical all knowing doctor or nurse knows she really is attention seeking, the pain issue is being dealt with correctly. It sometimes works to give the patient routine care, position for comfort, straighten up the room, etc., then tell her you will check in on her in (pick a number) 20 minutes. In 20 minutes do a quick check on her, tell her you will be back in 20 minutes, check in on her, tell her you will be back in 20 minutes, etc. Once she knows you will continue to check on her she should use the call light less. You should be able to stretch out the checks to 30 - 40 - 60 minutes. Of course this all sounds nice in theory, kind of like child rearing advice, it sounds great in the book, doesn't always work so well in the real world!

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Specializes in ICU, PICU, School Nursing, Case Mgt.

To all that called me out....Thank You!

To the OP...My apologies!

Standing corrected....Priceless!

Mea Culpa, Mea Culpa, Mea Culpa...

Sorry, Sorry, Sorry

Seriously,

I jumped the gun and you guys are right. I was tired and the topic hit home so I went off on a tangent.:o

Just so you all know, I would like Me taking care of anyones relative, I do listen to the patients complaints and pay attention to signs/symptoms and I do pay attention to detail (this post not withstanding). I do try to fix a problem whenever and however I can. Yes, I am a "crusty vet" but a am also a good nurse.

To the OP, again, I am sorry, Good luck with your interview and your career....and always read every question very carefully!:)

s

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Specializes in PICU, NICU, L&D, Public Health, Hospice.
Just for arguments sake, we will assume the magical all knowing doctor or nurse knows she really is attention seeking, the pain issue is being dealt with correctly. It sometimes works to give the patient routine care, position for comfort, straighten up the room, etc., then tell her you will check in on her in (pick a number) 20 minutes. In 20 minutes do a quick check on her, tell her you will be back in 20 minutes, check in on her, tell her you will be back in 20 minutes, etc. Once she knows you will continue to check on her she should use the call light less. You should be able to stretch out the checks to 30 - 40 - 60 minutes. Of course this all sounds nice in theory, kind of like child rearing advice, it sounds great in the book, doesn't always work so well in the real world!

The problem with this assumption "just for argument's sake" is that the determination that she is attention seeking and not in pain is that it is out of step with her diagnosis. As a previous poster indicated...fractured hip = pain. For ANYONE to "magically" determine that the expression of pain and request for relief is actually attention seeking is incorrect, inconsiderate, and unprofessional.

We should embark upon a very comprehensive pain assessment during which we may determine (with the patient's input) that she is experiencing more emotional pain or spiritual pain than physical pain, and this would require a change in the plan of care...perhaps something like you outlined. Or we might determine that the pain is physical and that there is a complication at the fracture site...or that the medication plan is woefully misdirected or insufficient in agent, dose, or frequency...etc. No matter what, the CNA does not have a role in that care planning.

The bottom line for the OP is that if you encounter a patient who says they are in pain you must notify the nurse, right away. If the nurse says that the patient is "faking pain for attention" she will very possibly NOT do what she should (which is to assess and treat according to POC)...no matter, you report patient pain each and every time you encounter it. The nurse will have to save herself from her wrong thinking.

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Specializes in LTC.

Swsrn- why don't you re read the original posts , then you will need to apologize to the OP.

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Pain is real to the patient. Depression is extremely painful. always report pain to the nurse. no one but the patient can determine if he/she is pretending. Sometimes just a little TLC like moving a pillow or holding an hand for a minute can actually help.

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Specializes in NICU.
Swsrn- why don't you re read the original posts , then you will need to apologize to the OP.

Um, she already did.

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Actually I think if a question like this comes up in an interview, they are not looking for "inform the nurse" as the only answer. Interview questions like this are designed to see what kind of thought process and initiative a prospective employee has as it pertains to their job. They are not looking for "answer the call light and tell the nurse the patient is in pain." Let's look at the scenario not as an RN but as a CNA:

Mrs. Jones is in the facility for a fractured hip. She constantly likes attn. by putting on the call light pretending to be in pain. Everyone on the hall is ignoring her. You pass by the room and hear her crying what is your response?

What does a prospective employer want? What can a CNA do?

Acknowledge and TALK to the patient. LISTEN to what their telling you. Pass that info to the nurse.

Make a point of introducing yourself and explaining what your there for. So many times staff forget to do this.

Recognize that when someone is constantly seeking attention it is often a sign. Mrs. Jones have any visitors? Perhaps she is lonely. Has she been hospitalized much? Perhaps she's scared and overwhelmed by all of this.

Recognize that maybe this person is lonely and scared and that may exacerbate her pain.

Taking the time to talk to the patient, even if it's about their garden or whatnot. Even if it's a few minutes. It's diversional and puts their focus on something other than their pain.

Providing information about what's going on, for example what time is breakfast, when are your going to wash her, if your going to reposition her tell her about before you start doing it. Patients can be overwhelmed when hospitalized and it's worse if they feel no one is keeping them informed. It's even worse when staff walk in and just start doing things to them.

Gather information about her pain, where it is, what's the score, does anything help make it better or worse? These are things you should report to the nurse.

Offer to reposition the patient.

Hourly rounds, they do make a difference.

Reassuring the patient, letting the patient know you won't forget them. Statements like: "Mrs. Jones I'll be back in about an hour to check up on you."

Ensuring things the patient may need/want and placed where they can be reached.

Following up with the nurse. "Hey, did Mrs. Jones get her pain medication?"

Collaborate with the nurse. Is it ok to offer a massage, hot or cold compresses.

I think you get the point. A perspective employer is trying to gage the person they're interviewing. Good luck Flordagirl, let us know how it goes.

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Swsrn- why don't you re read the original posts , then you will need to apologize to the OP.

NurseLoveJoy88, she DID apologize to the OP. Two posts before you posted the above.

To all that called me out....Thank You!

To the OP...My apologies!

Standing corrected....Priceless!

Mea Culpa, Mea Culpa, Mea Culpa...

Sorry, Sorry, Sorry

Seriously,

I jumped the gun and you guys are right. I was tired and the topic hit home so I went off on a tangent.:o

Just so you all know, I would like Me taking care of anyones relative, I do listen to the patients complaints and pay attention to signs/symptoms and I do pay attention to detail (this post not withstanding). I do try to fix a problem whenever and however I can. Yes, I am a "crusty vet" but a am also a good nurse.

To the OP, again, I am sorry, Good luck with your interview and your career....and always read every question very carefully!:)

s

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